Have you ever held a passport other than the passpo rt listed in your visa application? Have you travelled to any country (other than your country of residence) in the last 15 years? Yes No If yes, provide details for each trip that is not a lready included on your visa application (DS-156, D S-160, or DS-260), including locations visited, dat e visited, source of funds, and length of stay. Passport and Travel History Personal Information Surname(s) Given Name(s) Date of Birth (mm-dd-yyyy) Visa Type/Classification

If yes, provide the following information. Yes No Passport Number Country of Issuance

Given Name(s) Surname(s) Date of Birth ( mm-dd-yyyy ) Relatives Siblings (brothers and sisters) - Provide the full name(s) and date of birth of anysibling (full, half, step, adopted), living or dece ased.

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# SUPPLEMENTAL QUESTIONS FOR VISA APPLICANTS Approved OMB 1405-0226 Expires XX/XX/20XX Estimated Burden 55 Minutes U.S. Department of State General Instructions • If you are unsure of the answer to a questio n, please provide a response to the best of your kno wledge. For example, if you are unsure of an exact a ddress, provide the city, state, and street name if you can recall them. U.S. Department of State will consider all the information derived from the form in its en tirety. • Failure to answer every question will not n ecessarily preclude visa issuance, as the applicati on is considered in its entirety. • If you believe a particular question does n ot apply to you or your circumstances, please write "not applicable" or "N/A." • If you need more space to respond to a ques tion, please write the rest of your response on a se parate sheet of paper. • Aside from your name, date of birth, and vis a classification, please only provide information n ot included in your current visa application. For e xample, if all of your children are listed in your current visa app lication (Form DS-160 or DS-260), you do not need to list them again. CONFIDENTIALITY STATEMENT AUTHORITIES: The information on this form is request ed pursuant to Section 212(a) and 221 and as requir ed by Section 222 of the Immigration and Nationalit y Act. Section 222(f) provides that the records of the Department of State and of diplomatic and consularoffices of the United States pertaining to the issu ance and refusal of visas or permits to enter the United States shall be considered confidential and shall b e used only for the formulation, amendment, adminis tration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of such records may, in the discretion of the Secre tary of State, be made available to a court provided the co urt certifies that the information contained in such records is needed in a case pending before the court. PURPOSE: The U.S. Department of State uses the infor mation provided on this form to determine an individ ual’s eligibility for a U.S. visa. Individuals who fail to submit this form or who do not provide all the requ ested information may be denied a U.S. visa. Althou gh furnishing this information is voluntary, failur e to provide this information may delay or prevent the p rocessing of an individual visa application.Given Name(s) Surname(s) Date of Birth ( mm-dd-yyyy ) Relatives - Continued

Spouse- Provide the full name(s) of any current or previo us spouse or civil/domestic partner, living or decea sed.

Address and Contact Information Address- Provide all addresses where you have lived durin g the last 15 years, if not already provided in you r application. Dates of Residence ( mm-dd-yyyy ) Street Address 1 Address 1 Address 2

Street Address 2 City State/Province Postal Zone/Zip Code Country/Region Dates of Residence ( mm-dd-yyyy ) Street Address 1 Street Address 2 City State/Province Postal Zone/Zip Code Country/Region

DS-5535 Page 2 of 3 Given Name(s) Surname(s) Children - Provide the full name(s) and date of birth of any c hild (minor and adult), living or deceased. Childr en includes natural children, step-children, and ad opted children. Date of Birth ( mm-dd-yyyy )

Address- Provide all addresses where you have lived durin g the last 15 years, if not already provided in you r application. Dates of Residence ( mm-dd-yyyy ) Street Address 1 Address 3 Address 4

Street Address 2 City State/Province Postal Zone/Zip Code Country/Region Dates of Residence ( mm-dd-yyyy ) Street Address 1 Street Address 2 City State/Province Postal Zone/Zip Code Country/RegionEmployment History Provide the following information on all employment in the last fifteen years, if not already provided in your application. Dates of Employment ( mm-dd-yyyy ) Street Address 1 Street Address 1 Street Address 2 City State/Province Postal Zone/Zip Code Country/Region Dates of Employment ( mm-dd-yyyy )

Street Address 2 City State/Province Postal Zone/Zip Code Country/Region Employer Name Employer Name

Telephone Number Job Title Job Description Telephone Number Job Title Job Description

I understand all the information I have provided in , or in support of, this application may be provide d to other U.S. government agencies authorized to u se such information for purposes including enforcement of the laws of the U nited States. I understand all of the information contained in this form and I certify under penalty of perjury under the laws of the United States of America that the foregoing is complete, true, and correct. I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may result in refusal of the visa , denial of admission to the United States, and, ma y subject me to criminal prosecution and/or removal from the United States. Date ( mm-dd-yyyy

)

PAPERWORK REDUCTION ACT STATEMENT Public reporting burden for this collection of info rmation is estimated to average 55 minutes per respo nse, including time required for searching existing data sources, gathering the necessary documentation, prov iding the information and/or documents required, an d reviewing the final collection. You do not have to supply this information unless this collection disp lays a currently valid OMB control number. If you h ave comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov. Applicant's Signature DS-160/DS-260 Barcode Number For use by United States embassy or consulate official only:

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